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� <br /> ELECTRICAL PERMIT APPLICATION <br /> CITY OF EVERETT PERMIT SERVICES 3 -17�d� <br /> 3200 CEDAR STREET, EVERETT, WA 98201 �Oq O 3 0 77 <br /> 425-257-8810 - FAX 425-257-8857 —www.everettwa.org <br /> APPLICATIONS ARE ACCEPTED FROM 8 AM TJ 4 PM <br /> -,��50 L' v2�c�Y��c•r� W�� �'L'� 1 <br /> r���� ++ wr� �rb;�ay _ <br /> PROJECT ADDRESS <br /> ��/ha•w <br /> j�o I��{�e. <br /> Owner Mail Address City Stale/Zip Phone <br /> � �- n / D'r� 'L <br /> ��n� G7Iu+ Jn��%�i �D'�is'n /air�9J�re (n�'7 � /= �CJ�,GI /it/'1� 9� � 2c6-3S'I-�1.3� <br /> Tenanl Mail Addres� Cily Slate/Zip Phone <br /> C ll„'/�� <br /> Electrical Centractor hlail Address City Slate/Zip Phone <br /> State License Number Contract Price of Work <br /> Proposed Use of Building Contact Person (Plan Review) <br /> ,�r�..J���eLeY /,-� / l / <br /> Description ot Werk to Be Done: LG�G�K i� -L� ! 1 �73 +r��"h / � �eL�`� �`/S a��'� <br /> � <br /> NOTE: WIRING IN NON-DWELLINGS IS REQUIRED TO FEE <br /> BE IN RACEWAYS, MC OR AC CABLE. <br /> CITY OF EVERETT LOCAL SALES TAX CODE IS 3105 <br /> 1 hereby certi(y fhat 1 have read and examined this application and lc,�ow(he sarne to be true and <br /> coriecf. All provisions ol laws and ordinances govemmg this type of work wi116e comp/eted <br /> whefher specibed herein or not The granting ol a permd does not presume to give authonty to <br /> violate or cancel fhe provisions o(any ofher stafe orlocal law regulating construction or tho <br /> pedormance ol consl�uchon. That 1 am authorized by the owner ol this property to perform fhe <br /> work lor which application is made and 1 comply with the Sfafe Contractors Law 18.27 RCW and <br /> 296.200 WAC. <br /> _�--� <br /> -�����ii �^� - /7- °� <br /> S(c�na1 " '� Date <br /> �o�qo3-�� 7 <br />